RSV Vaccination in Adults: What Healthcare Providers Need to Know

Respiratory syncytial virus (RSV) is a common respiratory virus that nearly everyone gets by age two and can be caught multiple times throughout life. Adults who get RSV usually have mild symptoms like that of a common cold or have no symptoms at all. Historically, RSV has been associated with infants, but they are not the only group that can be affected by serious RSV illness. Older adults and adults with underlying medical conditions are also at increased risk.  

Understanding RSV in Adults 

For most adults, RSV symptoms include a runny nose, sore throat, cough, headache, fatigue and fever and resolve in one to two weeks. However, RSV can cause severe disease and hospitalization, with around 180,000 adults 50 or older being hospitalized in the United States each year. RSV can lead to exacerbation of existing chronic medical conditions like asthma and COPD, and some older adults may develop pneumonia. 

Understanding RSV Vaccination Options 

In 2023, the arrival of RSV vaccines for adults was a major advancement in public health. This development complements longstanding efforts to protect infants, providing a needed intervention across vulnerable populations. 

There are currently three RSV vaccine options available for adults: 

• Abrysvo (Pfizer) is a protein-based vaccine. Real-world effectiveness of Abrysvo during the 2023-24 season showed it was 79% effective in preventing RSV-associated emergency department visits and 73% effective in preventing RSV-associated hospitalizations in adults 60 or older.
• Arexvy (GSK) is a protein-based vaccine containing the same adjuvant used in the shingles vaccine. Real-world effectiveness of Arexvy during the 2023-24 season showed it was 77% effective in preventing RSV-associated emergency department visits and 83% effective in preventing RSV-associated hospitalizations in adults 60 or older.
• mResvia (Moderna) is a messenger RNA-based vaccine. Though mResvia is a newer product, its clinical trial data showed efficacy against symptomatic RSV was approximately 80% during the first four months following vaccination. Real world effectiveness is being monitored by CDC.

Adult Vaccination Recommendations 

Certain adults are at increased risk for severe RSV disease and complications and are recommended RSV vaccination. Those include: 

• All adults 75+
• Adults 50-74 with underlying medical conditions like chronic lung disease and risk factors like residence in a nursing home

Right now, revaccination is not recommended. The data is being monitored about how long immune protection from vaccination lasts. For example, a study recently published in JAMA looked at RSV vaccine effectiveness against hospitalization across two seasons. 

Coadministration with other adult vaccines (e.g., influenza and COVID-19) during the same visit is acceptable but may increase common side effects (pain at the injection site, fever, etc.). 

Addressing Common Patient Questions 

We discussed common patient questions with Robert H. Hopkins, Jr., MD, National Foundation for Infectious Diseases (NFID) Medical Director to help guide healthcare provider conversations.